LMICs in South Asia such as Nepal are no exception to the challenge of low uptake and continuation of IUDs including the ones used in the immediate post-partum period . Post-partumintrauterinecontraceptivedevice (PPIUD) is an effective and affordable long-acting post-partum family planning (PPFP) method which can be used immediately after childbirth within 48 h of post-partum period. It is known to be safe and has broad eligibility criteria for post-partum mothers [6, 7]. PPFP such as PPIUD was first introduced in Nepal between 2008 and 2009 . Despite the decade-long effort, the country still lacks nationally representative data on the usage of PPIUD separately. Moreover, the overall usage of IUD remains as low as 1.4% in the country .
Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partumintrauterinecontraceptivedevice (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion).
India contraceptive use is 54% but only 2% of married women of reproductive age use IUCD. Despite the fact that the govt. offers the IUCD service free of cost and IUCD is one of the most effective and safe contraception methods, it still remains largely underutilized. In order to improve the acceptance of IUCD, Indian government has introduced PPIUCD insertion in national programme, as the couples are being more counselled during antenatal visits and after delivery.
From the study results we came to the conclusion that PPIUCD is very effective, safe, and reversible contraceptive method which provides contraceptive effect soon after birth. Especially in those patients who have limited access to health care facilities and infrequent postpartum care, this method can be considered as the best for them. Although there is relatively higher incidence of expulsions in the both groups (10.8%-15.2%) as this also denotes that retention rate is about (84.8%-89.2%) even than must be encouraged for various advantages of PPIUCD. Acceptance (11%) is still low even after providing incentives to the providers as well as ASHA. This may be because counseling for PPIUCD was done mostly in labor room that must be started during ANC or by ASHA and MPHW-F (Multipurpose health worker- female). Misconceptions and myths regarding CuT are very much prevalent in this southern part of Rajasthan. Government needs to develop strategies to increase public awareness of the PPIUCD and to resolve the myths regarding CuT by using different media sources. ACKNOWLEDGMENTS
IUCD as their modern contraceptive method of choice. National program provides incentives to health care providers to promote sterilization, and very little importance is given to IUD or other temporary contraceptive methods. In this environment, it is not surprising that use of temporary contraceptive methods in the country is limited to 10.2 % and that of IUD only 1.8 % (NFHS 2006). 8 During the last 20 years, use of the
long term reversible method and may be an alternative to tubectomy. Its efficacy, compliance is high does not require daily self-administration and thus women can effectively avoid unintended pregnancies. Post-insertion symptoms are masked by the normal postpartum cramping and lochia. Postpartum insertion is convenient both for the women and the provider. Follow up can be scheduled along with immunization visits. A study on PPIUCD therefore, was done with the aim of future scope of the method, reasons for its acceptability, denial and associated complaints and complications.
The results show self-reported expulsion rate of roughly 3.8% among clients, with more than three-quarters of women reporting no complaints with their PPIUCD. Only 5.4% of women suffered from symptoms suggestive of in- fection after the insertion. Symptoms that were considered suggestive of infection included lower abdominal pain, fever, foul smelling/abnormal vaginal discharge, painful intercourse, and bleeding after intercourse. Other self- reported side normal effects of PPIUCD insertion included cramps and abdominal pain which 8.9% of women reported experiencing, along with 5.5% reporting minor menstrual problems. There were no cases of uterine perforation. Table 1 Demographic characteristics of clients who accepted Post-PartumIntrauterineContraceptiveDevice (PPIUCD) and were interviewed at the time of discharge from the facilities
This study highlights the safety and efficacy of postpartum insertion of intra uterine device copper T 380A among the parturients by following them for 6 months. Totally 2630 primipara were delivered of which 1828 women were included in the study and IUCDS were inserted based on the medical eligibility criteria after getting written informed consent. Insertion of PPIUCD was done after excluding women who came with draining per vaginum for >18 hours, maternal fever, uterine anomalies, fibroid uterus, postpartum haemorrhage - atonic or traumatic and systemic examination was done as given in the proforma. Acceptance rate is 69.50%.
Postpartum intrauterinecontraceptivedevice inserted within 48 h of delivery (PPIUD) is a safe, effective, and efficient method of meeting women ’ s need for long-acting but reversible method of contraception [1 – 3]. PPIUD is a particularly attractive method of contraception in a country like Nepal where women face several barriers to easily and repeatedly access healthcare services. The Nepali government has rec- ognized the potentially critical role of intrauterine de- vices (IUDs) in meeting the contraceptive needs of women and has been actively promoting it over the last decade. However, these efforts have had limited success with data from 2016 suggesting that IUD use among married women in the country was merely 1.4% .
Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterinedevice (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted. Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use.
According to a study on impact of health education on unmet needs of con- traception in urban slums of Chandigarh India, lack of awareness of contracep- tion methods contributes to low uptake of PPIUCD. Awareness here means that the mothers did not hear or see any advertisement about FP in the last 6 months or did not participate in any educational session about FP during last 6 months hence contributing significantly to low contraception uptake . Lack of know- ledge was also evident in Nyanza western Kenya in a study by Pauline et al.  who found that lack of contraception awareness and low uptake is related to none visit to antenatal clinic where education on family planning is mostly done. Social demographic characteristic also contribute to low uptake. In a study on factors influencing contraceptive non-use among women of advanced reproduc- tive age in Nigeria by Bola et al.  found that socio-demographic characteristics exert more influence on non-use. There was a significant relationship between non use and current young age where three-quarters of the non-users were 21 - 30 years old related to the desire to get children early in marriage. None use was significantly influenced by woman’s occupation as a housewife  in Nyanza western Kenya in a study on overcoming barriers to family planning through integration. As well, other studies revealed that the contraceptive use was found higher among employed women (67%) than that of unemployed women . Reproductive characteristics of the mothers are some of the barriers to the up- take . In a study of postpartum intrauterinecontraceptivedevice acceptance between primiparous and multiparous women in a tertiary care centre, accep- tance of PPIUCD was significantly higher in multiparous women than primi- parous . Number of living children, and child preference were found to be significantly associated with current use of contraception . Cultural Norms, Myths, Concerns and Miss Conceptions are other barriers.
Among the various method of family planning available for an women, insertion of post-partum IUCD appears appealing for several reasons: commencement of ovulation is unpredictable after delivery, women wish to avoid pregnancy, but still may not be using any form of contraception, delivery may be only time when a healthy women comes in contact with health care providers, ABSTRACT
The side effects of bleeding, pelvic infection, and pain are common reasons for removal of the method of contraception. Medical reasons for removal are partial expulsion, usually occurring in the first few months of use, persistent cramping, bleeding or anemia, accounting for about 20% of removals during the first 3 months, acute salpingitis, or Actinomyces on Pap smear, pregnancy, intra-abdominal placement or perforation; and significant post-insertion pain, which may indicate improper placement or partial perforation. 14 As is the
This study has been done to compare the complications of post placental IUCD insertion between caesarean section and vaginal delivery among women delivering in Agartala Government Medical College and at the same time benefit the female population of the state with long acting reversible contraception.
and are similar to the mechanisms of the progesterone-releasing IUD. The cervical mucus thickens and prevents the passage of sperm into the upper genital tract. The inflammatory changes induced by the plastic frame also contribute to efficacy by acting as a spermicide. The progestin suppresses the endometrium and occasionally suppresses ovulation. The side effects with this device are also influenced by the progestin. Menstrual changes are noted by most users. Women generally experience heavier bleeding in the first cycle but are more likely to experience oligomenorrhea, spotting, or amenorrhea in subsequent cycles. Although the progestin will not reliably suppress ovulation, it can show the atresia of existing follicles; therefore, an increased risk of functional ovarian cysts in associated with the levonorgestrel IUD. The circulatory levels of progestin are lower than with other progestin contraceptives, thus a few women may complain of bloating or breast tenderness with the levonorgestrel-releasing IUD. This IUD has many attractive feature.
institutional deliveries across the country, opportunities for providing quality postpartum family planning services has also been increased. Intrauterinedevice (IUD) insertion in the immediate postpartum period is a safe contraceptive approach which is also supported by the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Association of Women’s Health, Obstetric, and Neonatal Nurses. 7 During the postpartum period
The implementation of a convenient sampling method in the current study made it dif ﬁ cult to conduct inferential statistical analysis. The analysis basically speci ﬁ es the percentages of the female responses to issues related to knowledge of contraception and their practice. Only mar- ried women were included in the study, which may not re ﬂ ect the knowledge and practice of contraception use of the whole population. Sitting limitations include that the study was carried out in public clinics and centers, the sample was relatively inadequate to evaluate the knowl- edge and practices of less frequently used contraceptive methods. The knowledge in the present study was brief and limited to females ’ use. This means that knowledge about contraceptive methods was not covered in terms of mode of action, safety, and concerns. Cost and availability of the contraceptives as well as experience of the partici- pants with contraception might explain the inconsistency with other studies. Several knowledge domains were not evaluated like ef ﬁ cacy, mode of action and risk of com- plications of chronic use. The assessment of such domains may provide a clearer picture of women ’ s knowledge and practice.
I, DR.L.SHANMUGAVADIVU, solemnly declare that dissertation titled “COLPOSCOPIC AND CYTOLOGICAL CHANGES IN INTRAUTERINECONTRACEPTIVEDEVICE USERS - A PROSPECTIVE STUDY” is a bonafide work done by me at Govt. Kasturbha Gandhi Hospital, Madras Medical College, Chennai during 2003-2006 under guidance and supervision of Prof.Dr.S.Dhanalakshmi M.D., D.G.O., M.N.A.M.S., Superintendent, Govt Kasturbha Gandhi Hospital, Chennai.
Globally, 14.3% of women of reproductive age use intrauterine contraception (IUCD). In some countries, the percentage of women using IUC is <2%, whereas in other countries, it is >40% . It was a widely accepted method for many women avoiding the systemic effects of hormonal contraception and the lower efficacy of the local methods or other physiological methods. However, IUCDs had their side effects, including the most common cause for discontinuation of using the method: menorrhagia. Excessive uterine bleeding up to iron deficiency anemia is among the most common causes of discontinuation of using the de- vices .
IUDs utilization in Namibia has been stagnant at below 1% for more than two decades now, while injectables stand at 21% and male condoms 19%, while use of pills, female and male sterilization, and other modern contraceptive methods are all below 5% 4 . In some regions, the use of the IUDs is almost non-existent as it ranges between zero percent in Zambezi to 1.3 percent in Khomas region 4 . Even though the IUDs utilization rate in Khomas is slightly higher at 1.3% as compared to other regions, it is still very low 4 . The low utilization rate of the IUDs is an indication of under-utilization despite its proven high efficacy and safety 5-7 , while the majority of the FP acceptors rely on the injectables and condoms 4 . Moreover, FP services and contraceptives are offered free of charge at all public health facilities in Namibia to women of reproductive age (15-49 years) 8 .